Brochiectasis treatment goals focus on mobilizing airway secretions to decrease pulmonary infections and exacerbations, improve ventilation, and enhance quality of life. High frequency chest wall oscillation therapy (HFCWO) is an emerging therapy designed to facilitate mucus expectoration as an add-on technique for airway clearing techniques.
HFCWO is an effective technology that significantly lowers hospitalization costs and antibiotic consumption, and this cost impact analysis shows how early administration of HFCWO to bronchiectasis patients leads to savings for healthcare payers.
What is HFCWO?
High frequency chest wall oscillation therapy, or HFCWO, is an airway clearance technique which uses oscillatory forces to mobilize secretions. HFCWO can help clear mucus from the lungs, relieving symptoms associated with bronchiectasis. A 2013 study published in BMC Pulmonary Medicine demonstrated how HFCWO improves both pulmonary function and quality of life for those needing daily airway clearance therapy due to bronchiectasis.
This device consists of an air compressor with inflatable bladders attached to a vest via air tubing (see image 24-12). This device emits bursts of air at different frequencies (1-20 Hz) and pressures, producing oscillatory forces which help move mucus towards either mouth or nose.
Acoustics created by this device create air vibrations and sound waves to further break down mucus, leading to looser, less viscous mucus that is easier to cough up. Patients can wear this battery-operated vest while sitting, walking or moving around freely – it is the first battery-powered vest which allows users to access without being tied down by generators.
SmartVest was designed with ease of use in mind, requiring less power consumption and keeping costs at a minimum. Furthermore, its lightweight construction makes it quiet and tailored specifically to each patient. Plus, with its Connect app patients can track therapy sessions and share notes with clinicians – improving patient engagement and compliance!
An analysis published in 2018 demonstrated that long term use of a commercially available HFCWO device was associated with lower healthcare resource utilization 12 months post therapy start date, including reduced exacerbations; hospitalizations due to respiratory infections; and antibiotic prescriptions – potentially saving your patients both time and money – saving them lives in the process.
Who is HFCWO for?
HFCWO, an airway clearance therapy used to facilitate secretion clearance in those living with neuromuscular disease, can help them clear away secretions that lead to pneumonia and respiratory failure. Our cohort study utilized data from two large commercial insurance databases of commercial insurance claims to measure whether HFCWO leads to improved outcomes as measured by lower healthcare utilization for this population of people who had chronic neuromuscular conditions as well as conditions classified under International Classification of Diseases Ninth Revision codes that can be treated using HFCWO.
Results of this study suggest that patients using HFCWO experience fewer hospitalizations and outpatient visits after starting therapy, particularly among those at higher risk for exacerbations per the Brochiectasis Etiology and Comorbidity Index (BACI). Furthermore, improvement appears over a sustained period of over one year following start up of therapy – these findings support previous clinical trial findings which showed those using HFCWO experience more stable lung function with reduced instances of severe exacerbations than nonusers.
Airway clearance therapies like HFCWO can provide a safe and effective alternative to antibiotics in improving quality-of-life for those living with chronic conditions, like bronchiectasis. Noninvasive and self-administered at home, HFCWO allows people to continue working or enjoying hobbies while reducing costly medical care such as ER visits or hospitalizations.
As incidence of bronchiectasis continues to increase, physicians must provide innovative ways of managing this condition in order to help their patients improve quality of life and avoid further lung damage. To discover more about how the inCourage vest can enhance outcomes for bronchiectasis patients, visit this page.
How does HFCWO work?
HFCWO uses vibration to break up mucus and move it upward to the upper airways where it can be coughed up or suctioned away. Patients wear a vest that produces vibrations on their chest wall and connect it to a generator that delivers rapid bursts of air that cause it to inflate and deflate at specific frequencies, creating vibrations through their chest wall that loosen mucus on lung walls allowing it to be cleared by natural body mechanisms.
Studies have demonstrated the efficacy of HFCWO in reducing sputum production, improving lung function and quality of life, and decreasing respiratory morbidity. If used regularly as directed, HFCWO may even help decrease hospitalizations and enhance outcomes for those suffering from bronchiectasis.
One study demonstrated that twelve months after initiating HFCWO therapy, patients’ rates of hospitalizations and antibiotic usage significantly declined compared to those who hadn’t used this device. Health care costs also dropped for this patient group indicating that its cost may have been offset through decreased hospitalizations and antibiotic usage.
Another study discovered that patients receiving HFCWO treatment demonstrated improved self-reported pulmonary, emotional, and quality-of-life improvements as evidenced by decreased antibiotic requirements, hospitalization frequency, and length of stay for those experiencing single episodes of bronchiectasis.
Health care team will determine how often the SmartVest should be included as part of a patient’s regular treatment regimen, depending on his/her specific condition and severity of symptoms. Sessions generally last around 30 minutes each and can take place anytime throughout the day.
If your doctor suggests HFCWO as an option for treating you, speak with your insurance provider regarding coverage options. Most insurers cover its cost under specific conditions such as cystic fibrosis or nontuberculous mycobacteria infection.
What are the benefits of HFCWO?
Airway clearance is an integral component of treating respiratory conditions, such as cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFB). HFCWO, administered using a percussive vest, has been demonstrated to effectively clear mucus from patients living with CF, NCFB and other neuromuscular disorders such as amyotrophic lateral sclerosis (ALS), that impact breathing. HFCWO should be used alongside mucolytics and bronchodilators medications for optimal effectiveness.
HFCWO was discovered through a 2013 study that demonstrated it improved both pulmonary function and quality of life for CF patients requiring daily airway clearance therapy. HFCWO utilizes a battery-operated vest that delivers oscillating air pulses directly to the chest wall, stimulating movement of loosen sputum towards airway openings. Furthermore, every five minutes HFCWO pauses so patients can cough to release excess sputum from peripheral airways toward larger lung volumes.
HFCWO devices are easily portable and administered by either a physiotherapist, appropriately trained caregivers or patients themselves, depending on their condition. Improvements were measured immediately following four treatments as well as six, 12 and 24 months post-startup of HFCWO program initiation; significant correlations existed with times to start treatments vs results and these changes remained at statistical significance over a one year period.
Studies conducted with HFCWO vests demonstrated both improved respiratory health and reduced healthcare resource use for people living with ALS. One such analysis utilized medical claims data from a large US commercial payer to show hospitalizations related to respiratory issues decreased dramatically after patients began wearing HFCWO vests.
Researchers from Royal Philips conducted a recent retrospective pre-post cohort study and found that HFCWO was linked with decreased health care resource utilization and costs among chronic respiratory patients with bronchiectasis. They used PharMetrics’ health plan claims database to identify commercially insured adults with bronchiectasis who received either active or sham HFCWO, then compared hospital admissions and antibiotic prescription rates before and after starting HFCWO treatment – similar results to what has been seen from prior research that demonstrated HFCWO reduced both health care resource use as well as antibiotic use among these patients.
